Revise your Resuscitation: The Drowning Child

Following a scene assessment and checking for signs of life, what is the most important first step in this resuscitation?

After delivering your rescue breaths, you begin chest compressions, apply the defibrillator pads, achieve a definitive airway with an endotracheal tube and establish intra-osseous access (IO) in the anterior tibia. The child’s core temperature is 28.6ºC. Estimated weight is 14 kg.

You perform a rhythm check which shows this pattern on the defibrillator:

Fig.1 Adapted from Life in the Fast Lane⁴

What are the correct next steps in this circumstance?

After attempting to warm the child using external warming techniques, the core temperature reads 31.3ºC. The defibrillator still reads pulseless electrical activity (PEA) on the next rhythm check.

What are your next steps in resuscitation?